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Annals of Surgical Oncology
Erschienen in: Annals of Surgical Oncology 12/2013

01.11.2013 | Healthcare Policy and Outcomes

Resident Education in the Era of Patient Safety: A Nationwide Analysis of Outcomes and Complications in Resident-Assisted Oncologic Surgery

verfasst von: Anthony W. Castleberry, MD, MMCi, Bryan M. Clary, MD, John Migaly, MD, Mathias Worni, MD, MHS, Jeffrey M. Ferranti, MD, MS, Theodore N. Pappas, MD, John E. Scarborough, MD

Erschienen in: Annals of Surgical Oncology | Ausgabe 12/2013

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Abstract

Background

Complex, oncologic surgery is an important component of resident education. Our objective was to evaluate the impact of resident participation in oncologic procedures on overall 30-day morbidity and mortality.

Methods

A retrospective cohort analysis was performed using the National Surgical Quality Improvement Program Participant User Files for 2005–2009. Colorectal, hepatopancreaticobiliary, and gastroesophageal oncology procedures were included. Multivariate logistic regression was used to assess the impact of trainee involvement on 30-day morbidity and mortality after adjusting for potential confounders.

Results

A total of 77,862 patients were included for analysis, 53,885 (69.2 %) involving surgical trainees and 23,977 (30.8 %) without trainees. The overall 30-day morbidity was significantly higher in the trainee group [27.2 vs. 21 %, adjusted odds ratio (AOR) 1.19, 95 % confidence interval (CI) 1.15–1.24, p < 0.0001)]; however, there was significantly lower 30-day postoperative mortality in the trainee group (1.9 vs. 2.1 %, AOR 0.87, 95 % CI 0.77–0.98, p = 0.02) and significantly lower failure-to-rescue rate (defined as mortality rate among patients suffering one or more postoperative complications) (5.9 vs. 7.6 %, AOR 0.79, 95 % CI 0.68–0.90, p = 0.001). The overall 30-day morbidity was highest in the PGY 5 level (29 %) compared to 24 % for PGY 1 or 2 and 23 % for PGY 3 (AOR per level increase 1.05, 95 % CI 1.03–1.07, p < 0.0001).

Conclusions

Trainee participation in complex, oncologic surgery is associated with significantly higher rates of 30-day postoperative complications in NSQIP-participating hospitals; however, this effect is countered by overall lower 30-day mortality and improved rescue rate in preventing death among patients suffering complications.
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Metadaten
Titel
Resident Education in the Era of Patient Safety: A Nationwide Analysis of Outcomes and Complications in Resident-Assisted Oncologic Surgery
verfasst von
Anthony W. Castleberry, MD, MMCi
Bryan M. Clary, MD
John Migaly, MD
Mathias Worni, MD, MHS
Jeffrey M. Ferranti, MD, MS
Theodore N. Pappas, MD
John E. Scarborough, MD
Publikationsdatum
01.11.2013
Verlag
Springer US
Erschienen in
Annals of Surgical Oncology / Ausgabe 12/2013
Print ISSN: 1068-9265
Elektronische ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-013-3079-2

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